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It was early morning in an operating theater at in Portland, Ore. A middle-aged woman lay on the operating table, wrapped in blankets. Surgeons were about to cut out a cancerous growth in her stomach.

But first, an anesthesiologist 鈥� Dr.听 鈥� put her under by placing a mask over her face.

鈥淣ow I鈥檓 breathing for her with this mask,鈥� he said. 鈥淎nd I鈥檓 delivering sevoflurane to her through this breathing circuit.鈥�

听is one of the most commonly used anesthesiology gases. The other big one is. There are others too, like nitrous oxide, commonly known as laughing gas.

Whichever gas a patient gets is inhaled, but only about 5% is metabolized. The rest is exhaled. And to make sure the gas doesn鈥檛 knock out anyone else in the operating room, it鈥檚 sucked into a ventilation system.

And then? It鈥檚 vented up and out through the roof, to mingle with other greenhouse gases.

The two frequently used gases are fairly similar medically; sevoflurane needs to be more carefully monitored and meted out听in some patients, but that鈥檚 not difficult, Chesebro said.

Generally, unless there鈥檚 a reason in a particular case to use one over the other, anesthesiologists simply tend to pick one of the two gases and stick with it. Few understand that

And that bothered Chesebro. He grew up on a ranch in Montana that focused on sustainability.

鈥淧art of growing up on a ranch is taking care of the land and being a good steward,鈥� he said.

Now he lives in the city with his three kids听and has gradually started to worry about their environmental future.

鈥淲hen I look around and I see the stewardship on display today, it鈥檚 discouraging,鈥� he said.

鈥淚 got depressed for a while, and so I hit the pause button on myself and said, 鈥榃ell, what鈥檚 the very best that I can do?鈥欌��

He spent hours of his own time researching anesthesiology gases. And he learned desflurane is 20 times more powerful than sevoflurane in trapping heat in the Earth鈥檚 atmosphere. , whereas听sevoflurane breaks down in just one year.

Opening a big, black notebook filled with diagrams and tiny writing, he showed how he computed the amount of each gas the doctors in his group practice used. Then he shared their carbon footprint with them.

鈥淎ll I鈥檓 doing is showing them their data,鈥� Chesebro said. 鈥淚t鈥檚 not really combative. It鈥檚 demonstrative.鈥�

One of the doctors he shared his analysis with was Dr. Michael Hartmeyer, who works at the听听with Chesebro.

鈥淚 wish I had known earlier,鈥� Hartmeyer said. 鈥淚 would have changed my practice a long time ago.鈥�

Hartmeyer said he was stunned when Chesebro explained that his use of desflurane was the greenhouse-gas equivalent of 听for the duration of each surgical procedure. It鈥檚 鈥渙nly鈥澨� if he uses sevoflurane.听Hartmeyer noted that outside the operating room he drives a Prius, a hybrid electric car.

鈥淵ou try to be good,鈥� he said. 鈥淵ou take shorter showers or [don鈥檛] leave lights on, or whatever else. But you know there鈥檚 always more that we could probably do. But this was, far and away, a relatively easy thing that I could do that made a huge impact.鈥�

The anesthesiology carts that get brought into operating theaters tend to have a row of gases to choose from. Hartmeyer was able to switch pretty much overnight.

Other anesthesiologists made the switch, too. And it didn鈥檛 hurt that sevoflurane is considerably cheaper.

Hartmeyer鈥檚 change saved his hospital $13,000 a year.

When Chesebro shared his findings with the anesthesia departments at all eight听 in Oregon, they prioritized the use of sevoflurane. They now save about $500,000 a year.

Providence鈥檚听chief executive, , said the hospital system didn鈥檛 change its use of the gas because of the money. It changed because the 听now says climate change is the听听鈥� and because of Chesebro.

Vance said Chesebro teared up in front of 2,000 people when talking about the gas, his children and the听 character created by .

鈥淯nless someone like you cares a whole awful lot, nothing鈥檚 going to get better 鈥� it鈥檚 not,鈥� said Vance, quoting the book 鈥淭he Lorax.鈥�

, an associate professor of anesthesiology at听, called Chesebro鈥檚 efforts remarkable and important.

She said several hospitals around the country have tried to make this shift, but with mixed results. Some just gave anesthesiologists the information and not much changed. Other hospitals took desflurane away, but that left many anesthesiologists feeling disrespected and angry.

Chesebro succeeded, she said, because he chose to persuade his colleagues 鈥� using data. He showed doctors their choice of gas plotted against their greenhouse impact. And it helped that he showed them over and over, so doctors could compare their progress to their peers.

鈥淧roviding ongoing reports to providers is the best way for this movement to catch on and grow,鈥� she said. It can reinforce over time, she added, not just what their carbon footprint is, but also what progress they鈥檙e making.

Sherman said efforts such as Chesebro鈥檚 are sorely needed because the U.S. health sector is responsible for about .

鈥淲e clinicians are very much focused on taking care of the patient in front of us,鈥� she said. 鈥淲e tend to not think about what鈥檚 happening to the community health, public health 鈥� because we鈥檙e so focused on the patient in front of us.鈥�

In an emailed statement, one of the largest manufacturers of both the anesthesia gases 鈥� 鈥� said it鈥檚 important to provide a range of options for patients. The company also said inhaled anesthetics have a climate impact of 0.01% of fossil fuels.

鈥淭he overall impact of anesthetic agents on global warming is low, relative to other societal contributors, especially when you consider the critical role these products have in performing safe surgical procedures,鈥� the statement reads.

It鈥檚 a fair point, Chesebro said, but he has a counterargument.

鈥淲ell, if it鈥檚 there, it鈥檚 bad. And if I can reduce my life鈥檚 footprint by a factor of six 鈥� why wouldn鈥檛 you do it?鈥欌��

The surgery Chesebro was involved in that morning at Providence was a success. Chesebro estimates that by using sevoflurane on his patient, the amount of greenhouse gases produced was the same as in a 40-mile drive across the Portland region. If he鈥檇 used desflurane instead, he said, it would have been like driving the more than 1,200 miles from Seattle to San Diego.

Now Chesebro鈥檚 hospital bosses are hoping other doctors will follow his lead, research their own pet peeve and maybe solve a problem no one鈥檚 thinking about.

This story is part of a partnership that includes听,听and Kaiser Health News.